Engaging With Telehealth

If You Suspect the Patient Is in Danger, Tailor Your Approach for Telehealth

Screening for domestic violence during telehealth visits requires advance planning and a different approach than similar screening performed in the relative seclusion of a clinical office visit. Calling from home, patients living with a controlling or abusive partner or family member may not have the freedom privacy allows for honest reporting or even complete answers to screening questions.

In an open-access article in JAMA, Melissa Simon, M.D., points out that the normalization of telehealth means that clinicians must adapt techniques and tools in order to provide recommended screening for domestic violence, also known as intimate partner violence (IPV).

Screening for this kind of violence may be even more important now than before. Confined at home, dealing with increased stress related to finances, child care and other pandemic worries, and lack of access to alternate sources of support such as shelters are among the factors that have exacerbated existing threats of domestic violence: many people have increased stress and fewer options for help. A “Perspective” essay in the New England Journal of Medicine delves into this “pandemic within a pandemic” and offers tactics to use during telehealth visits and resources for patients.

Dr. Simon has specific advice for clinicians in telehealth visits with patients they suspect are experiencing IPV and who lack privacy to talk. For example, asking questions that can be answered with a simple yes or no can the clinician needed information without telegraphing the topic to those within earshot. She also recommends beginning with non IPV-related questions — for example, COVID symptoms — and then asking, “Are you feeling stressed?” or “Do you feel safe at home?” She also covers options for offering support and follow-up care, as well as an approach that screens everyone for IPV, not just those suspected of being in danger.

At their best, office visits offer personal engagement and connection that may be especially advantageous for patients who do not feel safe at home. The Perspective authors note other benefits: “Medical offices can be safe places for patients to disclose abuse. Physical examination findings; a patient’s behavior during or while discussing physically intimate components of a breast, pelvic, or rectal examination; or an aggressive partner can be warnings signs of possible IPV.”

For some, the intimacy of telephone or possibly video, could provide a similarly safe haven but only if privacy is ensured and there is sufficient trust in the clinical relationship for honest communication. That, too, is possible but different to create through telehealth — another way that telehealth concurrently offers challenges and opportunities.


Susan Carr Susan Carr is a medical editor and writer specializing in patient safety and engagement. In addition to curating the EngagingPatients blog, she produces publications for the Betsy Lehman Center in Boston and the Society to Improve Diagnosis in Medicine. Susan lives and works in Lunenburg, Massachusetts.

Susan Carr has 185 post(s) at EngagingPatients.org

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